be adjusted by slight pressure from above or by elevating the rims with a piece of adhesive tape over the bridge of the nose. The frame alone, without the tape, is often all that is necessary. In using the spectacle frame it is important to have the patient sitting upright, with the head erect and the eyes straight ahead. In this position, after a little practice, it is a simple matter to insert the cannula blindly after passing the anterior end of the middle turbinate.Apart from its usefulness in the aforementioned connection, the frame can be used in operations on the septum and the ethmoid cells. It is frequently helpful to know the level of the cribriform plate.During the past year this instrument has been used successfully at the Royal Victoria Hospital. It is now manufactured by the Storz Instrument Co., 4904 Laclede Ave., St. Louis.Recently two cannulas have come to my attention, one blunt, with more of a downward curve at the end,15 and the other a straight, sharp instrument with a vertical pin near the tip.16 Quite by accident these two main features have been incorporated in the cannula suggested.
SUMMARYThere are two methods of irrigating the sphenoid sinus : (a) through the natural ostium and (&) through puncture of the thin anterior wall of the sinus.Making an opening in the anterior wall has certain advantages ; material aspirated in this way is less liable to be contaminated, and irrigating fluid is syringed through more easily if there is free exit through the natural ostium.A sphenoid cannula is suggested and the method of introduction described.Preliminary roentgenograms are recommended, particularly the lateral view, to determine the level of the cribriform plate and the dimensions of the sphenoid sinuses. A method of ascertaining the level of the cribriform plate by means of a spectacle frame is suggested. This frame is also useful in many nasal operations.
Preliminary observations of the effects of irradiation on allergic nasal mucosa have been reported.1 It was stated in the last communication that (a) irradiation of forty patients suffering from verified vasomotor rhinitis gave excellent clinical results, these results remaining constant for one year, that (b) the method of irradiation described had proved safe during this period, and that (c) an analysis of the effects of irradiation in a series of patients with hay fever was under investigation. This work was presented before the Chicago Laryngological and Otological Society 2 and brought forth strong criticism as to both the permanency and the safety of the method of treatment of hyperesthetic rhinitis described. The possibility of latent atrophy resulting from irradiation was especially stressed.The purpose of this communication is (a) to evaluate the permanency and safety of this method of treatment of allergic rhinitis, sufficient time (three years) now having elapsed, and (b) to report the clinical results obtained by irradiation of twelve patients suffering from seasonal hay fever.A review of the histopathologic structure 3 of the nasal mucosa of patients with hyperesthetic rhinitis and seasonal allergic rhinitis recalls a picture of pronounced hyperplasia of the surface epithelium, absence of cilia, isolated areas of desquamation and edema of the subepithelial tissue, which is characteristically transitory. There is an infiltration of lymphocytes, plasma cells and eosinophils. As the disease This paper was submitted as a thesis in partial fulfilment of the requirements for membership in the American Laryngological, Rhinological and Otological Society.
In recent years the belief has been voiced by Jarvis and others that respiratory symptoms and pathologic changes in the respiratory system are brought about by faulty acid-base metabolism. Jarvis and his group have expressed the opinion that the color of the mucous membrane of the nasal septum is an index of the aci d\x=req-\ base balance in the body: pale septums being present in states of alkalosis, red septums in acidosis. The group of patients with pale septums, according to Jarvis,1 show a history of having eaten excessive amounts of foods producing alkaline ash and are susceptible to hay fever, asthma, hyperesthetic rhinitis, coryza and bronchial infection, whereas the patients with red septums give a history of having eaten excessive amounts of acid-producing foods and suffer from anorexia, lassitude, emotional instability, irritability, constipation, dry skin, insomnia, fatigue and repeated
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